All participants in the study will be patients who have been treated for Pulmonary Arteriovenous Malformation using Microvascular Plugs, Amplatzer Vascular Plugs or Detachable coils.

Pulmonary Arteriovenous Malformation

Patient's Pulmonary AVM(s) treated via transcatheter embolization with Microvascular Plugs.

Microvascular Plug (MVP)

Patient's Pulmonary AVM(s) treated via transcatheter embolization with Amplatzer Vascular Plugs.

Amplatzer Vascular Plug (AVP)

Patient's Pulmonary AVM(s) treated via transcatheter embolization with detachable coils.

Detachable coils

Johns Hopkins University

Microvascular Plug (MVP) for the Treatment of Pulmonary ArterioVenous Malformations (PAVMs)

Analyzed at 1 year and 3 years. Based on the investigators' preliminary data, reperfusion has been seen at 1-2 years in the patients the investigators have treated with coils and AVP making the 3-year goal for the investigators' prospective analysis feasible to cover reperfusion.

Immediate post-procedural technical success defined as complete occlusion of the feeding artery supplying the PAVM.

The number of embolic used per procedure will be used to determine the cost per PAVM.

Overall procedure cost for PAVM will be determined at 1 week after the procedure.

Radiation DAP measured in milligray-centimeters squared (mGy-cm^2).

Cumulative Air Kerma dose measured in milligray (mGy).

Cycle 1 (each cycle is 3 weeks): Bevacizumab 25 mg in 1 ml subcutaneously daily.

Cycle 1 (each cycle is 3 weeks): Bevacizumab 25 mg in 1 ml subcutaneously daily.
Bevacizumab 25 mg in 1 ml subcutaneously daily: Bevacizumab delivered by subcutaneous injection instead of intravenous infusion.

Bevacizumab

Sex: Female, Male

Ethnicity (NIH/OMB)

Race (NIH/OMB)

Region of Enrollment

To describe MRI response regarding edema and enhancement of glioblastoma and radiation-related brain enhancement when treated with subcutaneous bevacizumab daily. The therapeutic benefit of bevacizumab as regards glioblastoma multiforme (GBM) is largely due to the normalization of brain vasculature. This normalization appears on contrast-enhanced MRI as a reduction in enhancement and reduction in edema. For purposes of this study, any reduction in enhancement/edema by 25% or more will be considered a response.

Number of Participants With Change in Peritumoral Enhancement/Edema

Subcutaneous bevacizumab may have toxicities unique to the subcutaneous administration and not seen with intravenous bevacizumab. During the first 3 weeks we will watch for such toxicities. Toxicities will be described and graded using the Common Toxicity Criteria for Adverse Effects (CTCAE) v3.

Number of Toxicities Reported in Study Participants

Participants may switch from subcutaneous bevacizumab on study to standard of care intravenous bevacizumab. In these participants, we will measure decrease of edema after this switch. A further decrease in edema after making this switch would suggest intravenous to be superior to subcutaneous as regards decreasing edema. The therapeutic benefit of bevacizumab as regards GBM is largely due to the normalization of brain vasculature. This normalization appears on contrast-enhanced MRI as a reduction in edema. For purposes of this study, any reduction in edema by 25% or more will be considered a response.

Number of Participants With Change in Edema After Conversion From Study Treatment to Intravenous Bevacizumab

Overall Study

William L. Read, MD, Principal Investigator

Glioblastoma

Bevacizumab delivered by subcutaneous injection instead of intravenous infusion.

Bevacizumab 25 mg in 1 ml subcutaneously daily

Emory University Hospital Midtown

Emory University Winship Cancer Institutute

A Study of Subcutaneous Bevacizumab in Relapsed / Progressive Glioblastoma

A Phase II Study of Subcutaneous Bevacizumab in Relapsed / Progressive Glioblastoma

William Read

Principal Investigator

Emory University

A group of up to 30 healthy controls will be recruited to have a cardiopulmonary exercise test and a blood test.

A group of up to 30 pulmonary AVM patients will be recruited to have a cardiopulmonary exercise test, and a blood test.

Most patients with pulmonary AVMs have underlying hereditary hemorrhagic telangiectasia (HHT). If there is a difference between pulmonary AVM and control groups that does not correct following embolization of pulmonary AVMs, a group of up to 30 people with HHT but no evidence of pulmonary AVMs will be selected to have a cardiopulmonary exercise test and a blood test.

Pulmonary Arteriovenous Malformations

Hereditary Hemorrhagic Telangiectasia

On Day 1, subjects will have the test in the Exercise Suite of Hammersmith Hospital, London, UK. They will have painless skin probes placed on their fingers, chest, and legs to monitor heart rate, ECG, blood oxygen levels, and oxygen delivery during the test. Subjects will also be shown how to breathe through a mouthpiece with a nose clip on, and how to indicate on a sliding device whether they feel breathless. They will then start cycling against a very low resistance at a steady speed. As long as they feel comfortable, there will be a gradual increase in work load until they feel they cannot keep going at the same speed. They can also stop sooner for any reason. Afterwards, while they are "cooling down" (within the hour on Day 1), they will fill in a short questionnaire describing how they feel.

Cardiopulmonary exercise test

On same day (Day 1), the subject will have 20-30mls of blood (that is, 4-6 teaspoonful) taken for analysis.

Blood test

Hammersmith Hospital, Du Cane Rd

Cardiopulmonary Exercise Testing to Evaluate Pulmonary AVMs

Hypoxemia, Dyspnea, and Exercise Tolerance in Patients With Pulmonary Arteriovenous Malformations

Of the many measurements and derived indices that can be measured during cardiopulmonary exercise testing, the peak consumption of oxygen (VO2 max) is perhaps the best indicator of integrated cardiorespiratory capacity. The principle research question will therefore test the null hypothesis that "The VO2 max does not differ between PAVM patients and age matched healthy controls."

We will also test in univariate and multiple regression analyses whether breathing reserve differs between PAVM patients and controls.

We will also test in univariate and multiple regression analyses whether ventilatory efficiency differs between PAVM patients and controls.

telangiectasis/hypoxia

Microvascular Plug (MVP) for the Treatment of Pulmonary ArterioVenous Malformations (PAVMs)

A Study of Subcutaneous Bevacizumab in Relapsed / Progressive Glioblastoma

Cardiopulmonary Exercise Testing to Evaluate Pulmonary AVMs

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